Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | SLPA12216 | AZ |
NPI | 1407495591 |
---|---|
Provider Name | Mr. John Vincent Herrera |
First Address | Buckeye, AZ 85326-7135 |
Second Address | Scottsdale, AZ 85254-2369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2020 |
Last Update Date | 06/01/2020 |